AB0811 RESPIRATORY TRACT INFECTIONS AND RISK FACTORS FOR INFECTION IN A SPONDYLOARTHRITIS COHORT: IS THERE A DIFFERENCE BETWEEN PSORIATIC ARTHRITIS AND AXIAL SPONDYLOARTHRITIS?
Authors: N. Frede, E. Rieger, R. Lorenzetti, A. Venhoff, A. M. Kanne, M. Von Deimling, N. Bartholomä, J. Thiel, R. Voll, N. Venhoff
Journal: Annals of the Rheumatic Diseases (2022)

Background Respiratory tract infections (RTIs) are the most common infections in patients with rheumatic diseases under immunosuppressive treatment. RTIs may cause significant morbidity with reduced quality of life (QOL), increased healthcare costs and may lead to interruption of DMARD therapy. However, to date only limited data on infection risk in spondyloarthritis (SpA) patients are available. Objectives To assess the occurrence of respiratory tract infections in a real-world SpA cohort and determine associated factors. Methods Questionnaire-based screening and retrospective medical chart analysis of a monocentric cohort of 314 SpA patients comprising 168 psoriatic arthritis (PsA) and 146 axial spondyloarthritis (axSpA) patients. Results Out of 314 SpA patients, 89% had a history of upper respiratory tract infections (URTI) and 31.1% of lower respiratory tract infections (LRTI) within the last two years (Table 1). In a linear regression model LRTIs were associated with glucocorticoid (GC) therapy (p=0.015), CRP level (p=0.018), previous history of severe respiratory infections (p=0.007) as well as absence of HLA B27 (p=0.024). In general, patients with LRTIs were significantly older (p=0.007), had increased functional impairment (p&lt;0.001), a reduced health-related QOL (p&lt;0.001), poorer sleep quality (p=0.001) and more depression (p=0.001). 46% of patients had required antibiotics for RTIs within the last two years. Antibiotic therapy was associated with smoking (p=0.006), biologic therapy (p=0.005) and poor sleep quality (p=0.005). Smoking was associated with LRTI (p=0.009), but not URTI. Female patients reported a significantly higher frequency of LRTI (p=0.003), sinusitis (p=0.001), pharyngitis/laryngitis (p=0.009) and had received more courses of antibiotics than male patients (p=0.032). Table 1. Patient characteristics and infections axSpA (n=146 ) PsA (n=168 ) Total (n=314 ) Age, years, mean (SD) 49.6 (14.2) 57.4 (12.4) 53.8 (13.9) Male / Female, % 56.8 / 43.2 53.0 / 47.0 54.8 / 45.2 BMI, kg/m 2 , mean (SD) 27.1 (7.2) 27.4 (5.4) 27.3 (6.2) Smokers, n (%) 41 (31.8) 27 (16.3) 68 (23.1) HLA B27, n (%) (n=230) 97 (71.9) 23 (24) 120 (52.2) Therapy:n (%) csDMARD 29 (19.6) 84 (50.6) 113 (36.2) bDMARD 109 (75.2) 102 (60.7) 211 (67.4) Glucocorticoids 14 (9.9) 15 (8.9) 29 (9.4) Hypogammaglobulinemia (IgG&lt;7g/l), n (%) 5 (3.5) 6 (3.6) 11 (3.6) Polyclonal IgA (&gt;4g/l) elevation, n (%) 15 (10.9) 29 (17.8) 44 (14.7) URTI: n (%) 114 (88.4) 148 (90.2) 262 (89.4) Rhinitis, % 87.1 87.5 87.3 Laryngitis/pharyngitis, % 37 36.9 36.9 Sinusitis, % 40.5 30.2 34.7 Otitis media, % 14.3 6.8 10.1 LRTI: n (%) 39 (30.5) 52 (32.1) 91 (31.1) Bronchitis, % 28.0 30.6 29.6 Pneumonia, % 3.9 3.1 3.4 Pleuritis, % 2.4 1.2 1.7 There were no significant differences between PsA and axSpA regarding frequency of URTI or LRTI, though PsA patients had tendentially more overall RTIs. Biological therapy did not lead to a significantly increased occurrence of infections, but was associated with increased antibiotic therapy (p=0.039). Patients with a history of pneumonia had received anti-IL17 therapy more frequently (p=0.002), while there was no significant association with anti-TNF therapy (p=0.156). Patients on GC had a relative risk for LRTIs of 2.04. Hypogammaglobulinemia was rare in SpA patients (3.6%) despite continuous immunosuppressive treatment, occurred with equal frequency in axSpa and PsA patients and was associated with pneumonia (p=0.007) and increased antibiotic use (p=0.016). Polyclonal IgA elevation was observed in 14.7% of patients (mean 4.98g/l) and was associated with fewer episodes of rhinitis (p=0.027), whereas LRTIs and antibiotic use did not differ significantly. Conclusion This study quantifies the incidence and effects of RTIs in a real-world SpA cohort. While infections constitute significant adverse events of biologicals, and URTI were common, severe respiratory tract infections were rare. Differences in infection risk between SpA and PsA need to be studied more closely. Disclosure of Interests Natalie Frede Grant/research support from: Novartis study grant, Eva Rieger: None declared, Raquel Lorenzetti Grant/research support from: Novartis study grant, Ana Venhoff: None declared, Anna-Maria Kanne: None declared, Marcus von Deimling: None declared, Nora Bartholomä: None declared, Jens Thiel Speakers bureau: Novartis, AbbVie, Pfizer, BMS, UCB, Consultant of: Novartis, AbbVie, Pfizer, BMS, UCB, Grant/research support from: BMS, Novartis study grants, Reinhard Voll Speakers bureau: Novartis, AbbVie, Pfizer, BMS, UCB, Consultant of: Novartis, AbbVie, Pfizer, BMS, UCB, Lilly, Grant/research support from: Novartis study grant , Nils Venhoff Speakers bureau: Novartis, AbbVie, Pfizer, BMS, UCB , Consultant of: Novartis, AbbVie, Grant/research support from: Novartis study grant